Thyroid Gland:

Arterial supply

Vein supply

Arterial:

Superior Thyroid artery

Inferior Thyroid artery

Veins:

1. Superior Thyroid vein

2. Middle Thyroid vein

3. Inferior Thyroid vein

1. Parafollicular cells -C cells

synthesize & secrete Calcitonin

2. Thyroid cells

synthesize & secrete T3, T4

1. Solitary Nodule

2. Multinodular

1.  Non-toxic/ Diffuse multinodular goiter

2. Toxic multinodular goiter

Non-toxic/ Diffuse multinodular or Toxic multinodular goiter??

Excessive secretion of thyroid hormone that is independent of TSH

Seen in elderly- A-fib

Non-toxic/ Diffuse multinodular or Toxic multinodular goiter??

Thyroid enlargement not caused by autoimmune thyroid dz, thyroiditis, neoplasms

more prevalent in women

Thyroid:

If low TSH, what's the cause??

If TSH high, what's the cause??

low TSH:  Autonomous function of nodule

high TSH: Hashimotos

Thyroid goiters:

test

Tx

test:  US, FNA

Tx:  RAI therapy

Surgery

Thyroidectomy in younger pts with toxic goiter

Thyroid Goiters:

what does this indicate:

fixed

hard mass

cervical lymphadenopathy

airway obstruction

vocal cord paralysis

What are the effects of:

Calcitonin

Parathyroid gland:

cell type

function

Vitamin D function

cell type: Chief cells

function:  Increase blood calcium levels

Decrease serum phosphate levels

Vitamin D: increases intestional absorption of

calcium & phosphate

Parathyroid Gland:

Where is calcium absorption taken place by

 chief cells

&

Vitamin D

chief cells:  GI & Kidney

&

Vitamin D:  Duodenum & Proximal jejunum

Hyperparathyroidism:

primary cause

gender

condition

primary cause: Adenoma

gender:  Female

condition: Postmenopausal women

Hyperparathyroidism:

S&S

Dx

S&S:

Stones, Bones, Groans, Moans

Dx:

Hypercalcemia

decreased phosphate

increased chloride

US, Radiograph

Most common type of pituitary tumor?

Presentation??

Prolactinoma

Bitemporal hemianopsia

(blind lateral visual field)

Prolactinoma:

S&S:

 small & large

female & male

small: Hypogonadism 

 large: Hypogonadism, HA, Vision, loss of other hormone function

female: Infertility, amenorrhea, galactorrhea

 male: Infertility, sexual dys, impotence, loss of libido

PRU levels >100

MRI

Visual field testing

Adrenal gland tumor/Pheocromocytoma:

?? secreted

triad??

secretions: Catecholamines EPI & NOREPI

triad: Palpatations

HTN,H/A

Episodic diaphoresis

Adrenal gland tumor/Pheocromocytoma:

reveal??

24 hr urine

blood test

24 hr urine: metanepinephrine, vanillylmandelic

blood test:

Hyperglycemia

Hypercalcemia

Erythrocytosis

Cushing's Syndrome:

Define

Cause

Define: excess production of CORTISOL

Hyperadrenocorticism

Cause:

#1 Iatrogenic (prednisone)

#2 Cushing disease - ACTH secreting tumor

Cushing's Syndrome:

S&S

Depression

Moon face

Hirsutism

Acne

Buffalo hump

truncal obesity

HTN

DM

Purple striae

easy bruising

weakness

myopathy

Cushing's Syndrome:

Dx test

Dexamethasone suppression

synthetic cortisol

Conn's Syndrome:

define

causes

define:  overproduction of ALDOSTERONE independent of renin  "Primary Aldosteron"

causes:  65% Unilateral Aldosterone producing adenoma

35% Idiopathic hyperaldonsteronism

Conn's Syndrome:

Characterized by

H&P

Characterized by:  

HTN

Hypokalemia

Metabolic Acidosis

H&P:

Asymptomatic

Grade II retinopathy

Hypokalemia

Conn's Syndrome:

Dx

Tx

Dx:  plasma aldosterone & renin

if >20:1 = primary hyperaldosteronism

Tx:

Spirolactome

Surgery

Insulinoma:

??tumor type

S&S

tumor: Arises from beta cells that produce insulin

S&S:

Hypoglycemia

Palpatations

Diaphoresis

Tremors

Irritability

Weakness

Neuro:

personality changes

confusion

obtundation

seizures, coma

Insulinoma:

??

Whipple triad

1. Hypoglycemia sx produced by fasting

2. Blood glucose <50 during attack

3. Relief of sx w/ glucose administration

Insulinoma:

Dx

Tx

Dx:  CT, US, Venous Catheters

Tx:

 Medical-Diazoxide (suppresses insulin release)

Surgical: Resection

Testicular Torsion:

Define

Lead to ??

Classic Hx

Define:  twisting of the testicle & spermatic cord

Lead to: 

venous outflow obstruction & arterial occlusion=

Testicle Infarction

Classic Hx:

Acute onset of scrotal pain after vigorious activity or minor trauma

Testicular Torsion:

S&S

Dx

Tx

S&S:

Pain in scrotum

Tender

Swollen

Elevated testicle

Non illumination

absent cremaster reflex

Dx:  Surgery, US, Doppler flow

Tx:  surgical detorsion

Renal/Uterine Calculi-what forms these stones:

Calcium oxitate

Calcium phosphate

Sturvite

Uric Acid

Cystine

Calcium oxitate:  Most COMMON

extreme Ca++ ingestion, high animal protein diet, decreased fluid intake, sedentary life style, high oxidate consumption (iced tea, chocolate, greens)

Calcium phosphate: Distal renal tubularacidosis Type I

Primary Hyperparathyroidism

Sturvite: UTI (magnesium, ammonium, phosphate)

Uric Acid: High purine diet

Gout

Cystine: Genetic

Renal/Uterine Calculi:

S&S

Tx

S&S:

Severe pain

N,V

Cannot sit still

Hematuria

Febrile

CVA tenderness (costovertebral angle tenderness)

Tx:

IV fluids

Parenteral narcotics

Lithotripsi

Scopes

Prostate Cancer:

Adenocarcinoma or Squamous type??

 Disease of what population, age, ethnicity

Morbidity??

Adenocarcinoma 95% in US

 Disease of ELDERLY, 70-79 yrs, African American

2nd leading cause of death in men of US

Prostate Cancer:

S&S

METS to where

S&S:  ASYMPTOMATIC

DRE-prostate nodular

initially-periphery & advanced-centrally & hard

METS to where: think LLAB

Liver

Lungs

Adrenal

Bone

Prostate Cancer:

Dx

Tx

Dx: 

 Biopsy

TRUS Transrectal Ultra Sonography

Tx:

Radical Prostectomy

1. Prostrate gland

2. Seminal vesicles

3. Ampulla vas deferens

Testicular Carcinoma:

Carcinoma or Squamous type??

 Disease of what population, age, ethnicity

Carcinoma-Painless testicular mass

Common

Male

15-35 yrs

Caucasians

Testicular Ca:

In the differential dx, you have cystic dilation of head of epididymus, spermatocele, hydrocele

What clinical exam can be done to differentiate the cystic dilation from testicular cancer?

 cystic dilation of:

 head of epididymus, spermatocele, hydrocele

WILL TRANSILLUMINATE

Testicular Ca:

S&S

Dx:  what will be elevated in serum levels

S&S:

PAINLESS

initial diffuse swelling & pain

Dx:  what will be elevated in serum levels

AFP-alpha protein

BhCG-Beta human chorionic gonadotropin

LDH

Testicular Ca:

tx

If tx with ABX & sx get better, what does this indicate?

tx:

Radical inguinal hernia repair

Radiation

Chemotherapy

If tx with ABX & sx get better, what does this indicate?

NOT CANCER

SHOCK:

define, not symptoms

what % makes up mild, moderate, severe

Define: Physiological state where tissues are not being being PERFUSED-NO OXYGEN

BLOOD LOSS:

Mild: <20%

Moderate: 20-40%

Severe: >40% 

SHOCK:

Hypoperfusion lead to what at the cellular level which then lead to either metabolic alkalosis or acidosis??

?? Name the type of Shock:

Increased CO

Poor skin tugor

Thirst

Hemorrhage

Hypovolumic

LOSS OF WHOLE BLOOD & VOLUME

?? Name the type of Shock:

Vasodilation

nl/high CO

gram positive/negative present

SEPSIS

INFECTION

mostly gram +

?? Name the type of Shock:

Hypotension

Tachycardia

Tachypnea

LOW CO

JVD

Cardiogenic

Inability of heart to pump adequate blood to tissues

remember the blood flow is not going forward but is BACKING up

?? Name the type of Shock:

Anxiety, Dyspnea

GI cramps

Edema

Uticaria, Hives

Sensation of burning/itching

Drop BP

HIGH CO

decreased mentation

Anaphlaxis

Hypersensivity

Vasodilation of periphery & Vasoconstrictio of bronchi

Beck's triad:

JVD

Hypotension

Muffled sounds

CARDIAC TAMPONADE

There is an injury to:

 heart/coronary or internal mammary arteries

Heart is not able to pump

It is being compressed by the accumulation of fluid in the pericardial space

cardiac tamponade:

what is pulses pardoxus??

Cardiac Tamponade:

Causes

Tx

Causes:

Penetrating TRAUMA

gunshot

stab

Tx:

EVACUATE FLUID

Pericardiocentesis

Immediate thoracotomy & decompression

Renal/bladder trauma:

causes:

sx

dx

tx

causes: blunt trauma

penetrating trauma

iatrogenic injury

sx:  Hematuria

dx:  Contrast CT

tx:  Minor-observation

Surgery